A recent study in JAMA further examined cardiovascular risk and mortality in a retrospective review of more than 60,000 patients in the VA Health System. This study specifically identified patients with a diagnosis of pneumonia who were treated with antibiotics including azithromycin compared to other guideline-concordant antibiotics. Their outcomes of measure were 30-day mortality, 90-day mortality, any cardiovascular event, myocardial infarction, heart failure, or cardiac arrhythmias. The mean patient age was 78 years old and comorbid conditions were fairly common (35% with diabetes, 52% with COPD, 26% with heart failure).
Both 30- and 90-day mortality were lower in the azithromycin users (OR 0.76 and 0.73, p<0.001). There was a statistically significant increased odds of myocardial infaraction in the azithromycin group but there was no difference when looking at overall cardiac events, arrhythmias, or heart failure.
This study reinforces the net benefit of azithromycin in patients diagnosed with pneumonia and should allay concerns raised by the recent FDA warnings. But of course, make sure to practice appropriate prescribing and only prescribe antibiotics where they are clinically warranted.
References:
Mortensen EM, Halm EA, Pugh MJ, et al. Association of azithromycin with mortality and cardiovascular events among older patients hospitalized with pneumonia. JAMA 2014;311(21):2199-208.
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Azithromycin is one of the most widely used antibiotics in clinical practice. More than 50 million prescriptions are issued in the United States annually, typically for respiratory tract and sexually transmitted infections. It's shocking to know about cardiovascular risk in patients using azithromycin.
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